The cost of morbid obesity accounts for almost a quarter of the costs attributable to obesity in Brazil’s public health system, according to a paper ‘Direct Healthcare Cost of Obesity in Brazil: An Application of the Cost-of-Illness Method from the Perspective of the Public Health System in 2011. published in PlosOne. Although approximately 0.81% of the population are morbid obesity, the costs for treatment accounts for almost a quarter of the costs attributable to obesity totalling $64.2 million in 2011. Bariatric surgery was the single highest cost, accounting for $17.4 million of costs attributable to morbid obesity.

The study was designed to estimate the direct costs attributable to obesity (BMI≥30) and morbid obesity (BMI≥40) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011. The cost-of-illness method was adopted using a top-down approach based on prevalence and the proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web.

Obesity prevalence was obtained from the Consumer Expenditure Survey (Pesquisa de Orçamentos Familiares), which employed a nationally representative sample of the Brazilian households carried out by the Brazilian Institute of Geography and Statistics. Data from 55,970 households and 188,461 respondents were collected between 2008 and 2009. Weight and height were measured using a portable electronic scale and a portable stadiometer, respectively.

Outcomes

The total costs attributable to obesity and morbid obesity, which incurred on the Brazilian public health system budget in 2011, were US$269.6 million, which corresponded to 1.86% of all Ministry of Health’s expenditure related to hospital and ambulatory care in Brazil. Comparing the costs by healthcare level, 59.2% of the total cost was hospital admissions (inpatient care) and 40.8% corresponded to ambulatory procedures (outpatient care). When analysed by associated disease, obesity-attributable costs were highest for ischemic heart disease, followed by breast cancer, congestive heart failure and diabetes.

The estimated for morbid obesity were $64.2 million in 2011, with the highest costs attributable to morbid obesity for ischemic heart disease and diabetes. Despite the fact that morbid obesity was 18 times less prevalent than obesity, morbid obesity costs accounted for 23.8% of all obesity-related costs. Bariatric surgery was the single highest cost, accounting for 27.1% ($17.4 million) of this total. Between 2008 and 2011, the number of bariatric surgeries increased annually, as did the annual cost of such procedures (Table 1).

Table 1. Evolution of the number and annual cost (US$) of procedures related to bariatric surgery in the public health system, Brazil, 2008–2011.

In Brazil, the costs attributable to obesity in women were double the costs for men in 2011 with US$ 28.8 million corresponding to female cancers (endometrial, breast, and ovarian). The cost of morbid obesity in women was five times higher than it was in men.

It is generally accepted that the Brazilian public health system has a large unmet demand for bariatric surgery, the authors state. “It is estimated that 1.5 million adults in the country have morbid obesity and only 26,853 surgeries were performed between 2003 and 2011 in the Brazilian public health, in a country where about 75% of the population are dependent on public health services.

“When we compare the cost of the disease with its prevalence in the population, we find that the cost of morbid obesity (with a prevalence of 0.81% and a cost of $64.2 million) was proportionally 4.3 times higher than the cost of obesity (with a prevalence of 14.8% and a cost of $269.6 million),” they write. “This is consistent with the findings of other studies, which show a direct correlation between rising costs and higher BMI, except that we found the proportion of costs related to morbid obesity to be even higher than in other surveys.”

The researchers said that it is essential to strengthen the actions already started in Brazil for the prevention and control of obesity, such as:

increasing the supply and availability of healthy foods, including the reduction of prices of fruit and vegetables;

adopting effective interventions at all points of the health care network in order to ensure the completeness of obesity care in the public health system;

food and nutrition education, as the publication of the Food Guide for the Brazilian population and its dissemination;

restrict unhealthy food marketing, especially for children.

“If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system,” warn the authors from the University of Brasilia, Brasília, Federal District, Brazil. “With regard to public policies, it is essential to strengthen the actions already started in Brazil for the prevention and control of obesity…studies of this nature need to be conducted on a regular basis in Brazil in order to monitor the economic impacts of the obesity epidemic in the coming years.”